These drugs are ideal for continuous infusions and PCEA dosing. Side effects after neuraxial administration of opioids are dose dependent and are generally similar when used either epidurally or intrathecally. They include respiratory depression with somnolence, pruritus, nausea, vomiting, and urinary retention. Neuraxial opioids were first used for labour analgesia in following the description of spinal cord opioid receptors in Via these receptors in the dorsal. the ASA Task Force on Neuraxial Opioids," adopted by ASA in and published A. Definitions of Neuraxial Opioid Analgesia and Respiratory Depression.


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Their study failed to demonstrate any significant antipruritic or analgesic effects of celecoxib in neuraxial opioids single dose of mg administered after delivery of baby within the first 24 h post-operatively but Samimi et al.

Antihistamines H1 blockers have little or no effect on centrally induced pruritus; although, first-generation H1 receptor antagonists such as diphenhydramine or hydroxyzine may produce a sedative effect, which could sometimes, be helpful in patients with neuraxial opioids.

They primarily interrupt the itch-scratch cycle by providing needed sleep but are not really effective at reducing the severity of the neuraxial opioids.

It exerts its antipruritic action through the inhibition of the posterior horn transmission in the spinal cord.

Secondly, mirtazapine can work on the cerebral cortex to reduce the perception of pruritus. Thirdly, mirtazapine had strong antihistamine effect.

Neuraxial (epidural and intrathecal) opioids for intractable pain

From the pharmacokinetic viewpoint, mirtazapine has another advantage over the first-generation 5-HT3 neuraxial opioids antagonists. The peak concentration of neuraxial opioids is reached 2 h. Dopamine D2 receptor antagonist Droperidol and alizapride has also been used for the treatment of opioid-induced pruritus.

Both are potent dopamine D2 receptor antagonist.

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Droperidol is also having weak antiHT3 activity. In the study by Horta et al.

Metoclopramide, another dopamine D2 receptor neuraxial opioids has been shown to be ineffective in this regard. Several studies have shown gabapentin to be effective in in many chronic pruritus conditions. Neuraxial opioids, the effectiveness of antipruritic dosage and the other pharmacological mechanisms of gabapentin need further study.

Prevention The treatment of neuraxial opioid-induced pruritus is complex even after, significant research in these fields. We yet fail to describe a definitive treatment.

Neuraxial (epidural and intrathecal) opioids for intractable pain

Believing that prevention is better than cure and we suggest the use of minimal analgesic doses of neuraxial opioids, use of neuraxial opioids in combination with a local anesthetic, which offers satisfactory analgesia with a very low incidence of pruritus.

Conclusion Pruritus is a well-recognized adverse effect of neuraxial opioids. Several drugs are available for use including opioids, local anaesthetics and adjuvant drugs such neuraxial opioids clonidine and ziconotide.

This review will focus mainly on the use of neuraxial opioids for CNMP and cancer-related pain; a brief description of the action of the other drugs will be provided but not discussed in full. Patient selection Neuraxial analgesia is considered for use in patients who have resistant intractable pain that fails to respond to other treatment options or pain that responds to analgesia but for which the doses required neuraxial opioids in unacceptable side-effects.

In rare circumstances it may be used for rapid, effective analgesia when there is limited time available for titration of oral or subcutaneous analgesia e. Exclusion criteria relate specifically to psychological and psychiatric illness, allergy and certain neuraxial opioids conditions which may be relative or absolute contraindications.

If a significant psychological disorder, personality disorder, addictive personality or frank psychiatric illness is detected during the assessment and history-taking process then the patient is not neuraxial opioids suitable.

Neuraxial opioid-induced pruritus: An update Kumar K, Singh SI - J Anaesthesiol Clin Pharmacol

One of 32 clinics used epidural morphine, for malign gynaecological surgery. Postoperative monitoring is generally organised within the initial 2—6 hours in the postoperative ward and the following hours, up to 12 hours, in the regular surgical ward, according to the guidelines of SFAI — Swedish Association of Anaesthesia and Intensive Care.

In case of CS the initial 2—6 hours of postoperative monitoring are located to either the postoperative ward or obstetrical ward as it was in eight hospitals as neuraxial opioids and in some hospitals occasionally and the following hours, up to 12 hours, in the regular ward.


Epidural morphine was used to a lesser extent. Opioids were also commonly added to labour analgesia as sufentanil, but neuraxial opioids unit uses morphine as an adjunct in labour analgesia.

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